Home Health & Hospice Week

Overpayments:

Take Some Steps Now, Some Later For Overpayment Compliance In Light Of 60-Day Rule

Be ready to run with the new regs.

What can home health and hospice agencies do as they await the feds’ next move on potentially severe overpayment regulation changes? Here are some smart ideas.

Reminder: In the 2024 Medicare Advantage Program Proposed Rule issued in December 2022, the Centers for Medicare & Medicaid Services included its intent to amend existing regulations for Medicare overpayments (Parts A, B, C, and D) and the requirements to report and return them. But when CMS issued the MA Final Rule on April 5, 2023, it completely ignored the overpayment revisions. It said the agency was not addressing comments received on provisions not finalized (e.g., overpayments) but warned it will address them at a later time. (See more details in HHHW by AAPC, Vol. XXXII, No. 28.).

Given the significant liability of the law as it exists now, and the operational difficulties and potential for even a greater liability the proposed changes raise, experts strongly recommend agencies assess their existing processes to ensure they are compliant with the current 60-day rule.

Ask yourself:

  1. Do we have an effective compliance program in place?
  2. Are we timely addressing credible allegations of overpayments?
  3. Are we not only conducting timely, reactive investigations; are we performing well-timed activities to proactively identify potential overpayments?

Next, watch for CMS’ reply to public comments on the overpayment proposed changes, and be ready to:

  • quickly review the agency’s responses,
  • fully assess CMS’ final adopted provisions,
  • promptly discern and implement any systems modifications,
  • immediately revise policies and procedures, and
  • promptly and thoroughly retrain staff.

Remember: The door is still open. Agencies must keep a watchful eye.

Other Articles in this issue of

Home Health & Hospice Week

View All